title: Fatal transplant-associated west nile virus encephalitis and public health investigation-california, 2010.
abstract: BACKGROUND
  In December 2010, a case of West Nile virus (WNV) encephalitis occurring in a kidney recipient shortly after organ transplantation was identified.
  
  
  METHODS
  A public health investigation was initiated to determine the likely route of transmission, detect potential WNV infections among recipients from the same organ donor, and remove any potentially infected blood products or tissues. Available serum, cerebrospinal fluid, and urine samples from the organ donor and recipients were tested for WNV infection by nucleic acid testing and serology.
  
  
  RESULTS
  Two additional recipients from the same organ donor were identified, their clinical and exposure histories were reviewed, and samples were obtained. WNV RNA was retrospectively detected in the organ donor's serum. After transplantation, the left kidney recipient had serologic and molecular evidence of WNV infection and the right kidney recipient had prolonged but clinically inapparent WNV viremia. The liver recipient showed no clinical signs of infection but had flavivirus IgG antibodies; however, insufficient samples were available to determine the timing of infection. No remaining infectious products or tissues were identified.
  
  
  CONCLUSIONS
  Clinicians should suspect WNV as a cause of encephalitis in organ transplant recipients and report cases to public health departments for prompt investigation of the source of infection. Increased use of molecular testing and retaining pretransplantation sera may improve the ability to detect and diagnose transplant-associated WNV infection in organ transplant recipients.
authors.affiliation: Centers for Disease Control and Prevention, Fort Collins, CO, USA. IRabe@cdc.gov
authors.forename: Ingrid B
authors.initials: IB
authors.lastname: Rabe
authors.forename: Brian S
authors.initials: BS
authors.lastname: Schwartz
authors.forename: Eileen C
authors.initials: EC
authors.lastname: Farnon
authors.forename: S Andrew
authors.initials: SA
authors.lastname: Josephson
authors.forename: Allison B
authors.initials: AB
authors.lastname: Webber
authors.forename: John Paul
authors.initials: JP
authors.lastname: Roberts
authors.forename: Angelo M
authors.initials: AM
authors.lastname: de Mattos
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Gallay
authors.forename: Sean
authors.initials: S
authors.lastname: van Slyck
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Messenger
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Yen
authors.forename: Evan M
authors.initials: EM
authors.lastname: Bloch
authors.forename: Clifton P
authors.initials: CP
authors.lastname: Drew
authors.forename: Marc
authors.initials: M
authors.lastname: Fischer
authors.forename: Carol A
authors.initials: CA
authors.lastname: Glaser
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011634:Public Health; D014019:Tissue Donors; D014901:West Nile Fever / Q000635:transmission*